Provider Demographics
NPI:1760517916
Name:GELLER, ROXANE (LAC, LMP)
Entity Type:Individual
Prefix:
First Name:ROXANE
Middle Name:
Last Name:GELLER
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 15TH AVE E STE 304
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5156
Mailing Address - Country:US
Mailing Address - Phone:206-409-0566
Mailing Address - Fax:206-709-9657
Practice Address - Street 1:340 15TH AVE E STE 304
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5156
Practice Address - Country:US
Practice Address - Phone:206-409-0566
Practice Address - Fax:206-709-9657
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1869171100000X
CA10361171100000X
WA13623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist